Healthbeat

Medicaid cuts hit lawfully present immigrants Oct. 1. Here are 5 things to know.

2026-09-29T15:22:04+00:00

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State health officials are warning millions of people who rely on Medicaid about nationwide changes coming in January.

But another important change is happening on Oct. 1.

That’s when thousands of lawfully present immigrants will lose their eligibility for federally funded Medicaid coverage.

The change, which state Medicaid agencies are racing to carry out, is required under a sweeping tax and spending law, sometimes called H.R. 1 or the One Big Beautiful Bill Act, that was signed by President Donald Trump last year.

Here are five things to know about what’s changing on Thursday.

Click here to continue reading.

Alison Young is Healthbeat’s senior national reporter. You can reach her at ayoung@healthbeat.org or through the messaging app Signal at alisonyoungreports.48

As Medicaid cuts loom, NYC launches push to keep residents covered. Here’s what you need to know.

2026-09-21T16:30:46+00:00

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A major tax and spending package President Donald Trump signed into law last year will slash federal Medicaid spending by nearly $1 trillion over the next decade and make sweeping changes to healthcare programs serving millions of Americans.

The Trump administration says the tax and spending cuts will eliminate waste, fraud, and abuse. Because of stricter eligibility requirements, shorter retroactive coverage periods, and more frequent eligibility verifications, an estimated 17 million Americans — many of them children, pregnant women, people with disabilities, seniors, and veterans — are expected to lose their coverage by 2034, according to KFF.

H.R. 1 — also called the One Big Beautiful Bill Act, the Working Family Tax Cuts Act, and the reconciliation package — will also affect the Supplemental Nutrition Assistance Program, or SNAP, and New York state’s Essential Plan, an insurance program for qualifying low-income New Yorkers. But its biggest healthcare impacts fall on Medicaid enrollees.

City officials and community health leaders have launched a push to inform enrollees about the Medicaid changes.

The city’s Health Department has held more than 40 training sessions for community organizations, hosted monthly webinars, and fielded more than 3,000 benefits-related calls last month. The city says it has also sent guidance to 35,000 providers.

On Wednesday, senior health officials held the first of three virtual sessions to explain the changes and answer questions, drawing more than 250 people. Additional webinars are scheduled for Oct. 21 and Nov. 18.

“We’re going to act, take measures we’ve never taken before, and push ourselves to answer the call to make sure we are keeping our city’s residents covered in every way that we can,” Health Commissioner Dr. Alister Martin said in his opening remarks.

Healthcare systems are ramping up direct outreach, too. Sun River Health, with centers in New York City, the Hudson Valley, and Long Island, is running text and mailing campaigns to notify patients before their coverage lapses, said Allison Dubois, the organization’s chief operating officer and executive vice president.

“We’re worried about them getting the correct information in the right amount of time,” Dubois said.

Here’s a look at how H.R. 1 will change healthcare coverage and who is especially vulnerable.

When do the work requirements take effect?

Beginning Jan. 1, 2027, enrollees ages 19 through 64 must show that they are working, attending school at least part time, volunteering, or participating in a job-training program for at least 80 hours per month to keep their coverage. Enrollees who earn at least $580 a month, which is 80 times the federal minimum wage, can also meet the requirement.

Some adults will also need to renew their Medicaid coverage every six months instead of annually. Eligible people who apply for Medicaid before Jan. 1, 2027, or renew before March 1, 2027, will get 12 months of coverage. People who apply after Jan. 1 or renew after March 1 will need to renew every six months.

Who is exempt from the Medicaid work requirements?

Women who are pregnant or were pregnant within the past 12 months, recipients with disabilities, and recipients enrolled in substance-use treatment programs are exempt.

How many New Yorkers could be affected?

At least 475,000 people statewide could lose their Medicaid coverage because of the new work requirements, according to the New York State Department of Health. The department also estimates that New York’s uninsured population could increase by 45%, from approximately 1 million people to as many as 1.45 million after implementation.

New York has already seen a preview of this disruption. On July 1, 450,000 New Yorkers lost coverage through the Essential Plan after the state narrowed insurance eligibility for some of its low-income members. The Essential Plan offers a low-cost insurance plan to New Yorkers who earn too much to qualify for Medicaid but may struggle to afford private plans sold through the state health insurance marketplace. The program has been popular with gig workers.

As of Aug. 30, 41% of the affected members had not enrolled in another plan through the state marketplace, according to the state Health Department, potentially leaving some without insurance.

Those who no longer have insurance can turn to NYC Care, a healthcare access program that guarantees low-cost and no-cost services for New Yorkers.

What parts of New York City will most likely be affected?

A Healthbeat analysis of Medicaid enrollment data found that the Bronx could bear the brunt of the Medicaid changes. New York’s 15th Congressional District, which includes parts of the Bronx, has 510,000 Medicaid enrollees, the highest number of any congressional district in the country. They account for 71% of the district’s population.

The Bronx is “ground zero for what H.R. 1 means in practice,” Urban Health Plan, a local community health center, said in a press release. Between 20,000 and 30,000 borough residents could lose their coverage through Medicaid or the Essential Plan, the organization estimates.

Queens and Brooklyn are also especially vulnerable. According to the United Hospital Fund, 1.1 million Brooklyn residents, or 45% of the borough’s population, and 973,091 Queens residents, or 42% of the borough’s population, are enrolled in Medicaid.

How might the H.R. 1 changes affect the city’s hospitals?

Health advocates point out that changes to Medicaid won’t affect just the enrolled population, but the broader healthcare system.

“If you think, ‘I got a job, I got insurance, I’m fine,’ you are completely misunderstanding the way that this is a complete ecosystem,” state Sen. Gustavo Rivera, whose district includes parts of the Bronx and who chairs the Senate Health Committee, told Healthbeat.

Those who are uninsured, he said, are “going to be landing in emergency rooms, pushing institutions that are safety nets into further crisis, potentially getting some of them to close.”

That pressure could be especially acute for NYC Health + Hospitals, the largest municipal healthcare system in the United States, which operates 11 public hospitals across the city.

According to Deborah Brown, senior vice president and chief external affairs officer of NYC Health + Hospitals, it’s also the city’s largest provider of healthcare to homeless New Yorkers. Nearly 70% of its adult patients are enrolled in Medicaid or uninsured. Medicaid covers 97% of the babies born in the system and 70% of its patients younger than 18.

“The populations that we serve continue to be the most marginalized populations in NYC,” Brown wrote in a July letter to Dr. Mehmet Oz, administrator of the Centers for Medicare & Medicaid Services. “We are heavily reliant on Medicaid revenue to keep our doors open.”

How has New York pushed back against federal Medicaid changes?

In June, New York Attorney General Letitia James, 24 other states, and the District of Columbia filed a lawsuit against the Trump administration challenging a separate federal rule that they say makes it harder for Medicaid enrollees to demonstrate their eligibility. For example, if a Medicaid enrollee is being treated for cancer, they may need to provide additional paperwork demonstrating the severity of their illness.

Visit nyc.gov/MedicaidHelp for resources and guidance, or call 347-665-0214 to speak with a New York City Health Department counselor.

Trenton Daniel is a reporter covering public health in New York for Healthbeat. Contact Trenton at tdaniel@healthbeat.org or on the messaging app Signal at trentondaniel.88.

Medicaid provider lists promise pregnant women care that isn’t always there. A key reform is years away.

2026-09-15T17:31:06+00:00

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Medicaid is a critical healthcare safety net for millions of pregnant women: More than 40% of U.S. births are paid for by the program. Yet having Medicaid coverage is no guarantee it will be easy to find a doctor or midwife to provide care.

To find one, many women turn to their Medicaid plan’s provider directory. But getting an appointment can require navigating a gauntlet of obstacles: wrong phone numbers, and providers who aren’t actually in the network, providers who no longer practice at listed locations, and practices that aren’t accepting new patients.

Every call takes time when timely prenatal care matters.

As the country grapples with a maternal health crisis, federal investigators warn that problems with Medicaid managed care networks could be making it more difficult for pregnant women to get the care they need.

The issue has been known for more than a decade. Yet a key federal reform intended to expose “ghost providers” in Medicaid networks is still two years away.

Here’s what I found.

The Lead Signal

Medicaid’s maternal care networks may be bigger on paper than in reality.

A recent investigation by the U.S. Department of Health and Human Services Office of Inspector General warned that inaccurate Medicaid provider directories could put pregnant women at risk of delaying or missing important maternal care.

At issue: The provider list errors can make it frustratingly difficult to access care.

The OIG’s investigators examined online directories for a large sampling of OB/GYN physicians and certified nurse-midwives listed as participating in plans from the three largest insurance companies that offer Medicaid managed care plans: Centene, Elevance, and UnitedHealthcare.

These companies’ Medicaid plans covered more than 29 million people in 38 states during 2025, the investigators said.

Yet the OIG’s reviews of provider directories for the companies’ Medicaid managed care plans in Louisiana, Missouri, Nevada, New Jersey, and Washington found significant omissions and errors, including the listing of “ghost providers,” according to the OIG report released this summer.

Ghost providers is the term the OIG used to describe maternal care providers who shouldn’t have been listed in the plans’ directories because these providers weren’t participating in the networks that covered patients’ care.

“Some providers reported that they were never in-network with the plan or they practiced in a different State and did not accept out-of-State Medicaid plans,” the report said.

Investigators found that 22% of the maternal care providers Centene’s directories were not actually in-network for the Medicaid managed care plans reviewed. Listing providers who aren’t in-network also can mislead Medicaid enrollees when they are choosing between plans, the report said.

A screenshot from the HHS OIG’s report that found inaccurate Medicaid provider lists may limit patients’ access to maternal care.

Not only were the lists riddled with providers who weren’t in-network, they failed to include numerous maternal providers who were participating in the companies’ care networks, the investigators found.

And when participating providers were listed, their contact and office location information frequently was inaccurate, making it more difficult to search online for nearby providers.

“Enrollees may delay or forgo care if they experience challenges in finding an in-network provider, which can contribute to worse maternal health outcomes,” the report said.

The problem wasn’t limited to just the directories patients use.

In a companion investigation, the OIG examined the lists that plans operated by Centene, Elevance, and UnitedHealthcare submitted to state Medicaid officials to show their networks had enough providers to meet patients’ needs.

About one-quarter of the listed maternal health providers weren’t in network, despite being represented to the states that they were.

A screenshot from the OIG’s companion report that said inaccurate managed care plan lists submitted to state Medicaid officials may compromise oversight of patient access to maternal care.

None of the three companies cited in the OIG reports responded to interview and comment requests over several weeks. A spokesperson for Medicaid Health Plans of America, an industry organization whose members include the three companies, referred Healthbeat back to the companies.

Why It Matters

“Imagine sitting on the phone and trying to call to find out if they offer care in between your 15 minutes of time that you have on your lunch break,” said Tina Sherman, national director for maternal health at the advocacy group MomsRising. “It’s almost impossible. Which has been why some families end up entering prenatal care late, which also has ramifications of not getting the full scope of care that they need.”

States pay Medicaid managed care plans a set amount for each person enrolled in their coverage. The companies control costs through a variety of measures, including having a limited group of in-network health care providers who agree to accept the plan’s payment rates.

The plans are supposed to have enough providers to deliver care.

David Machledt, the director of the managed care portfolio at the National Health Law Program, said the OIG reports confirm long-standing concerns about Medicaid networks. He has worked on these issues since 2014 and said he was struck by the size of the provider discrepancies.

“It was actually bigger than what I would have expected,” said Machledt, whose nonprofit organization works to protect the rights of low income and underserved communities.

The Policy Response

Taxpayers pay Medicaid managed care plans hundreds of billions of dollars to provide care, according to the OIG.

For more than a decade, the OIG has called for greater scrutiny and oversight to ensure that Medicaid managed care plans have adequate provider networks. These federal watchdogs have pointed toward “secret shopper” surveys as a powerful oversight tool.

During secret shopper surveys, investigators pose as Medicaid enrollees or a family member and try to schedule appointments. Instead of relying on a plan’s paperwork, the surveys test how easy it is for patients to get care.

In 2024, a Medicaid managed care access rule required states to conduct annual secret shopper surveys to assess compliance with wait times and the accuracy of provider directories. Obstetrics and gynecology is one category of care that must be assessed.

But these assessments won’t start being required nationwide until 2028.

States don’t have to wait.

At least 28 states have used secret shopper surveys in recent years, according to a policy brief published last year.

But not all of them check on maternal care networks.

State Spotlight: Missouri

Missouri’s Medicaid program, MO HealthNet, already uses secret shoppers, but not for OB/GYN care.

The state’s recent secret shopper reports have focused on the accuracy of Medicaid provider directories for primary care providers and psychiatrists.

The state plans to add OB/GYN care to its annual reviews by 2028, said Baylee Watts, a spokesperson for the Missouri Department of Social Services.

Missouri was among the five states in the Health and Human Services OIG probe that found significant inaccuracies in maternal care provider lists.

“MO HealthNet has shared the findings from the HHS OIG reports with Missouri’s contracted managed care organizations,” Watts said by email, adding that maternal health care is a priority and the department provides help to Medicaid participants needing assistance.

A new vendor system for processing provider information should also improve the reliability of directories, Watts said.

What to Watch

Machledt said states have tools to hold managed care plans accountable. The question, is whether they’ll use them.

Every wrong number and unavailable provider shifts the burden of finding care onto patients, Machledt said.

“None of the beneficiaries who are making these phone calls are being paid for the time that they’re investing,” Machledt said. And the bureaucratic hurdles, he said, can lead people to give up on seeking care.

“That can have downstream effects that are really expensive for the system, and more importantly, are consequential to that person’s health.”

Tell us your Medicaid story: Healthbeat wants to hear what’s working and not working with Medicaid. Send your tips to ayoung@healthbeat.org.

Alison Young is Healthbeat’s senior national reporter. Sign up to receive her free national newsletter here. You can reach her at ayoung@healthbeat.org or through the messaging app Signal at alisonyoungreports.48

New Medicaid work rules put NYC enrollees and hospitals at risk. Here’s who will be hit the hardest

2026-08-19T12:00:00+00:00

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Of the estimated 67 million people in the United States who will likely be affected by Medicaid cuts, about 3.6 million recipients live in New York City, and more than 1.3 million are concentrated in three congressional districts.

Those districts cover parts of the Bronx, northern Manhattan, and Queens, according to a Healthbeat analysis of district data and KFF, a nonprofit organization focusing on health care issues.

New Yorkers rely on Medicaid programs for everything from HIV treatment to home healthcare. The new changes to Medicaid — the public health insurance program for millions of low-income Americans that’s paid for by the federal government and individual states — are the result of H.R.1, the budget package that passed last summer and will slash $1 trillion from the Medicaid program over the next decade. As of Jan. 1, enrollees between ages 19 to 64 must prove that they are working, going to school, volunteering, or participating in a job-training program for at least 80 hours per month to keep their coverage. The rules are intended to push more people into the workforce and reduce what Republicans have described as waste and fraud in government programs.

The New York State Department of Health estimates that at least 475,000 New Yorkers could lose their Medicaid coverage because of the new work requirements. The health department also estimates that New York’s uninsured population could jump by 45%, from approximately 1 million people to as many as 1.45 million people after implementation. A new rule for cancer patients stipulates that a diagnosis is not sufficient for a work exemption; they must officially prove they are unable to work.

The Bronx leads the United States with the highest number of Medicaid enrollees, with 510,000 in Congressional District 15. People walk inside the NYC Human Resources Administration, part of the Department of Social Services, in the Bronx. The social service agency provides assistance to New Yorkers, including Medicaid enrollees.

Health advocates say the Medicaid changes won’t be limited to enrollees and will have a cascading effect in communities and their hospitals. New Yorkers who lose coverage will likely forgo check-ins with their primary care physician, if they have one, causing preventable ailments to worsen and require emergency room visits. Hospitals are required by law to treat uninsured patients and will have to absorb the costs, which will likely accumulate. They’ll receive an influx of newly uninsured patients that will exacerbate overcrowding, forcing facilities to scale back on services that are expensive or aren’t lucrative, like pediatrics or primacy care, said Johanna Lister, policy director for the HealthySteps program at ZERO TO THREE, a nonprofit group focusing on early childhood.

“They need to cut based on how they need to protect their remaining incoming revenue,” Lister said.

Some hospitals will be forced to close.

“The financial impact of hospitals is going to be huge, particularly for safety net hospitals, like in the Bronx,” Lister said about the healthcare facilities that provide treatment regardless of the patient’s ability to pay or insurance status. “There’s absolutely no doubt that hospitals will close.”

A coalition of more than two dozen attorney generals and governors, including New York, filed a lawsuit in June against the Trump administration challenging the new

work requirements.

‘Canaries in the coal mines’

In a recent interview with Healthbeat, New York City Health Commissioner Dr. Alister Martin said he was particularly concerned about three areas: the south Bronx, East Harlem, and the Brownsville neighborhood in east Brooklyn.

“These are some of the areas that I think are really critical for us to watch and to see, almost as canary in the coal mines,” said Martin, whose department has brought on specialists to help Medicaid enrollees navigate the new requirements and has hosted public meetings to answer inquiries. His press office couldn’t say how many Medicaid enrollees the counselors have supported.

A Healthbeat analysis of Medicaid data from congressional districts in New York City reveals the following:

The Bronx leads the United States with the highest number of Medicaid enrollees, with 510,000 in Congressional District 15. That’s 71% of the district’s population. According to the Urban Health Plan, a community health center in New York State, the Bronx is “ground zero for what H.R.1 means in practice.” Between 20,000 to 30,000 residents in the borough could lose coverage on Medicaid and a separate plan for working-class New Yorkers, and up to $211 million could be pulled out of the Bronx food economy, says the Urban Health Plan.
Congressional District 13, which includes northern Manhattan and parts of the Bronx, is also in the top 10 districts in the United States whose residents rely on Medicaid. That is 426,200 residents, or 59% of the population. The district also has the highest number of seniors in the city enrolled on Medicaid, with 69,900.
Congressional District 14 has 57% of its population enrolled on Medicaid, or 423,800 residents. The U.S. representative for the district that includes the eastern Bronx and north-central Queens, Alexandria Ocasio-Cortez, said in a social media post earlier this month she was meeting with Deputy Mayor Helen Arteaga Landaverde to work on a strategy for combatting the cuts and expanding healthcare. Her office, and other offices for the New York City congressional delegation, did not respond to a list of questions about Medicaid.
New York City’s 11th Congressional District, which includes Staten Island and part of Brooklyn, is in the top 10 of districts with Republican congressmembers, with 304,100 Medicaid enrollees, or 40 percent of its population. It’s the only New York City congressional seat represented by a Republican, Nicole Malliotakis.

Unaware and unprepared: New requirements endanger coverage for millions

Health advocates fear that Medicaid enrollees may overlook important notices or be unaware of the new requirements or not understand them, either because of a language barrier or because the instructions are hard to understand, and then miss important deadlines and fall off.

Bronx resident Frances Bueno might be among them. The 62-year-old Puerto Rican woman said she was unaware of the changes to Medicaid.

“Yeah, I read something like that,” Bueno said after stepping out of a community health center in the Mott Haven neighborhood in the south Bronx. A Medicaid recipient since last year, she had just paid a visit to her neurologist, who canceled the appointment, she said, and she was on her way to buy meat with food stamps.

“It’s going to be rough on a lot of people out here,” she said.

A sign outside the NYC Human Resources Administration in the Bronx directs visitors to a Medicaid office. The Bronx leads the United States with the highest number of Medicaid enrollees, with 510,000 in Congressional District 15.

The Bronx, Queens, and Brooklyn are especially vulnerable. According to the United Hospital Fund, an independent nonprofit analyzing health policy in New York, 843,415 people in the Bronx, or 60% of the borough’s population are enrolled on Medicaid; 1.1 million in Brooklyn, or 45% of the population; 973,091 people in Queens, or 42% of the population, 421,264 people in Manhattan or a quarter of the population; and 171,290 people in Staten Island, or 35% of the population, are enrolled on Medicaid.

With this in mind, New York State Senator Gustavo Rivera, whose district includes the Bronx, has introduced the New York Health Act, a piece of legislation that aims to establish a single-payer healthcare system at the state level.

“I’m convinced that this is the way that we need to go,” Rivera, chair of the Senate Health Committee, told Healthbeat. “Taking insurance companies out of the equation means giving better care, having it cost less, and providing it to more people.”

New Yorkers with questions about their coverage can call the New York State Medicaid Helpline at 800-541-2831.

Trenton Daniel is a reporter covering public health in New York for Healthbeat. Contact Trenton at tdaniel@healthbeat.org or on the messaging app Signal at trentondaniel.88.

How New York’s ‘Essential Plan’ insurance coverage cuts are forcing impossible choices

2026-06-18T16:20:29+00:00

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Olivia Killingsworth, an actor and bookkeeper living in Brooklyn has a rare life-threatening genetic condition for which she sees specialists, limits exercise, takes prescribed medication to lower her blood pressure, and monitors her heart rate with a watch.

The 44-year-old is one of some 450,000 New Yorkers who could lose health insurance at the end of the month.

That’s because of a change to the state’s “Essential Plan,” a low-cost health insurance option that covers people who earn too much money to qualify for Medicaid and too little to afford private plans sold on the state health insurance marketplace.

On July 1, New York plans to revert to an earlier plan that will narrow insurance eligibility for low-income residents, potentially leaving thousands suddenly uninsured and looking for coverage options.

Killingsworth and others like her may find themselves in an unusual predicament as they weigh their health insurance options: Do they try to earn more money so they might qualify for a plan that proves to be more expensive or do they work less so they earn less money to be eligible for a separate plan?

“People are really going to be in the situation of making incredibly difficult choices,” said Michael Kinnucan, health policy director at the Fiscal Policy Institute, a nonpartisan think tank that aims to promote sound and equitable fiscal policy to strengthen New York’s economy.

When New York launched the Essential Plan in 2016 with funding from the Affordable Care Act, it was hailed a success. The plan offered no monthly premiums or deductibles, and annual checkups were free. In a state whose monthly premiums for marketplace plans are among the most expensive nationwide, it became wildly popular, now offering high-quality and affordable insurance to 1.7 million New Yorkers.

Of those, about 450,000 are in households making up to 250% of the federal poverty line. That is $39,900 a year for a single adult with no children, like Killingsworth who last year earned around $35,000, or $80,375 for a family of four. The state received federal permission in 2024 to expand eligibility to those New Yorkers.

But the passage of H.R. 1, the Trump administration’s One Big Beautiful Bill Act, changed that. The legislation prompted the state to shrink eligibility and undo its expansion, and the income limit for eligibility dropped from 250% to 200%. There are no changes for the 1.3 million enrollees with income below 200% of the federal income poverty level, or an income below $31,920.

New York City’s Department of Health and Mental Hygiene estimates that 233,000 New York City residents will lose their Essential Plan coverage. The New York State Department of Health, which worked with the Urban Institute, a think tank in Washington, D.C., on its projections, anticipates between 150,000 and 200,000 will become uninsured.

Actor and bookkeeper Olivia Killingsworth gives a health update to her physical therapist Melanie Carminati as part of her PT appointment.

New Yorkers who lose their insurance can go to a federally qualified health center — typically a community health clinic — for preventative care, dental care, and other services and pay on a sliding scale. Or they may visit a medical school that has a student-run clinic offering free or low-cost care.

With so many suddenly losing their insurance, there will be plenty of blame to go around.

“The responsibility for those losing coverage rests squarely with House Republicans, and now New Yorkers are beginning to feel the impact,” New York Health Department spokesperson Danielle De Souza said in a statement.

Killingsworth and health advocates like Kinnucan disagree. They argue that Gov. Kathy Hochul didn’t do enough to preserve coverage in the budget for Essential Plan enrollees. Lawmakers said she could have dipped into funds that she had set aside for her January budget proposal. But the argument failed to gain traction in negotiations.

“We had an opportunity in the state budget to prevent it,” said Kinnucan. “There’s this weird thing that happens with policymakers, where healthcare in theory is some sort of entitlement program that you can cut, but the people who use healthcare are sick and they really need help.”

Olivia Killingsworth poses for a portrait after leaving her physical therapy appointment in Brooklyn.

Killingsworth diagnosed with rare connective tissue condition

In 2019, Killingsworth was diagnosed with Ehlers-Danlos Syndrome, or EDS, a rare group of connective tissue disorders. She has what’s referred to as the vascular kind, which means her connective tissue is very fragile, particularly in the blood vessels and organs. That type of EDS runs in the family and can cause life-threatening complications, such as an aneurysm, and affects roughly 1 in 100,000 to 200,000 people, according to the Ehlers-Danlos Society, an advocacy organization that aims to promote awareness about EDS.

“I’m a 44-year-old woman with the joints and connective tissue of a 74-year-old,” said Killingsworth, who has dyed parts of her graying hair purple.

Killingsworth hasn’t performed as an actor since 2021 but is hoping to return to the stage or TV soon. Treatment keeps her busy.

Care requires visits to a niche cardiologist and a vascular specialist, both at Mount Sinai on the Upper East Side; she consults them on taking long bike rides and is under orders not to over exert herself.

Olivia Killingsworth does exercises with her physical therapist Melanie Carminati at her studio in Brooklyn.

She also sees a physical therapist almost weekly who specializes in EDS, one of the few in the city, if not the country. Each visit runs $250. The physical therapist, the owner of a Brooklyn studio, doesn’t accept insurance like many other physical therapists, because she believes it would limit the quality of care. It’s a stretch for Killingsworth to pay out of pocket, but she can make it work because her other healthcare has been covered.

Killingsworth’s father was diagnosed with EDS, and she believes her aunt likely had it, dying at the age of 70 in 2018 because of an aortic rupture, Killingsworth said. Her aunt’s inheritance allowed her in 2022 to pay cash for her one-bedroom apartment in Brooklyn’s Kensington neighborhood where she lives with her two cats. She paid $521,000, public records show.

Killingsworth realizes that she is lucky enough to live in one of the world’s most expensive cities without having to pay a mortgage or rent. That recognition compelled her to participate in an organized protest in April outside Hochul’s office in Midtown Manhattan. A member of the Democratic Socialists of America who canvassed for Mayor Zohran Mamdani when he ran for office last year, Killingsworth was part of a group arrested in the April demonstration on trespassing charges, which were later dropped.

“I have a college degree, I have a lot of skills, I can do a lot of stuff,” Killingsworth said. “I know that there are lots of other people that aren’t from that position and are facing much worse conditions. They don’t have the same options that I do. So that’s one of the reasons that I wanted to go out there and take that arrest.”

Killingsworth joined the Essential Plan in 2024 and it was a godsend. Because of her yearly salary of around $35,000, she qualified for a plan for New Yorkers whose annual income was more than 200% of the federal poverty line and less than 250% of the federal poverty line. The annual income is between $31,920 and $39,900.

If she were to purchase a plan through the marketplace, she would pay more.

According to a calculation on the marketplace offered by New York state, Killingsworth is eligible for more than 60 plans. The NYS Health Department says that consumers with income between the 200% and 250% poverty line will be eligible for a plan with an estimated average premium of $220 after tax credits and a deductible of $2,150.

If Killingsworth were to pursue one of these plans, she says she would stay with her current insurance whose services she has liked. One estimate she obtained shows she could pay a monthly premium of $432 after tax credits with an annual deductible of $2,050 — reaching a minimum of $7,234 total, or 20% of last year’s income. This doesn’t include costs for imaging, specialists’ visits, or her physical therapy sessions.

She is inclined to see if she can join another tier on the Essential Plan.

There is no monthly premium or deductible, and the maximum out of pocket is $350. A visit to see her cardiologist would cost $25.

To be eligible, Killingsworth would need to work fewer hours so she could earn less money. Her annual salary can’t exceed $31,920.

Trenton Daniel is a reporter covering public health in New York for Healthbeat. Contact Trenton at tdaniel@healthbeat.org or on the messaging app Signal at trentondaniel.88.

Georgia ranks 48th for Hispanic health care, driven by high uninsured rates

2026-04-29T04:01:00+00:00

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Georgia ranks second worst in the nation for Hispanic health care, with high rates of uninsured adults and children, according to a report released Wednesday by The Commonwealth Fund.

The report used data for 24 health indicators from 2023 and 2024 to rank how states’ health systems perform for different racial groups.

Poor access to care and low quality of services drove Georgia’s 48th-place ranking for Hispanic health. Only Arkansas had a worse score. (There was insufficient data to rank Vermont and Tennessee; Washington, D.C., ranked second).

In Georgia, 40% of Hispanic adults are uninsured, compared to 23% nationwide. Likewise, 18% of Hispanic children are uninsured, compared to 10% nationwide.

That can make it hard to get care, said David Radley, senior scientist at The Commonwealth Fund, a private foundation that conducts health research and promotes health equity. Only 56% of Hispanic children had age-appropriate medical and dental care visits, lower than other ethnic groups in Georgia.

About 1.1 million Hispanic people live in Georgia, about 11% of the state’s population. The segment has grown by nearly a third since 2010, according to a report published by the Latino Community Fund and Neighborhood Nexus in 2024.

Still, the state’s Hispanic residents have better health outcomes on some indicators than other groups.

For example, Hispanic and Asian American people have much lower breast cancer death rates (at 10 per 100,000 female population) than Black and white Georgians.

That’s an example of what health researchers call the Hispanic or Latino paradox: “Hispanic people, in general, have a hard time accessing care, but they also have better health outcomes,” Radley told Healthbeat.

One factor may be age: Georgia’s Hispanic population is younger than the state’s overall population, Radley said.

The median age for Georgia’s Hispanic population is 27.7, compared to 37.6 for the state as a whole, according to U.S. Census data.

Gigi Pedraza, executive director of the Latino Community Fund, said, “People from Latin America that migrate to the U.S. (and in general most immigrants) have better health outcomes that decline the longer we stay in the U.S.”

Once here, they may lack access to healthy foods, have less physical activity, and face social and economic stressors, she said.

Many Hispanic people in Georgia are self-employed, may work physically demanding jobs and cannot afford health insurance. They often cannot access safety-net programs due to their immigration status.

Undocumented immigrants are not able to purchase insurance through the Affordable Care Act or qualify for Medicaid or Medicare in Georgia. The One Big Beautiful Bill passed by Congress and signed by President Donald Trump in July further restricts Medicaid eligibility for many lawfully present immigrants, such as refugees, asylum seekers, and survivors of domestic violence and trafficking.

Anti-immigrant rhetoric and fear about deportations also has contributed to people’s reluctance to seek health care, Pedraza said.

“Parents feel it is not for their families, they cannot trust the system or their decision-makers,” she said.

Asian Americans had the best overall score in Georgia, indicating better health care access, quality, and outcomes, followed by white people.

Health disparities persist for Black Georgians

Health system performance for Black Georgians was slightly better than other states’, but disparities remain, Radley said.

“Tragically, this is reflected across the age continuum,” said Dr. Harry Heiman, a professor at the Georgia State University School of Public Health.

For example, 10.7 Black infants per 1,000 live births die in Georgia, similar to the 10.9 rate for Black people nationally. But that’s more than double the rate for white infants in Georgia, Radley said.

Likewise, while Black women have high rates of screening for breast cancer, Black women die of breast cancer at higher rates than other racial groups.

Sixteen percent of Black adults in Georgia are uninsured, compared to 12% nationally.

People skipping health care due to costs

Overall, health care costs appear to be one driver of poor outcomes in Georgia, in line with nationwide trends.

Rates of people who skipped care because of cost hit record lows in 2021 and 2022, according to The Commonwealth Fund report. That was likely due to pandemic-era policies, such as enhanced premium tax credits for ACA insurance plans and continuous enrollment for Medicaid, Radley said.

Now those numbers have started to increase again nationwide.

High uninsured rates and lack of access to care affect many Georgians, regardless of their race, Heiman said, and reflect “system and structural-level failures that affect all Georgians.”

Georgia is one of 10 states that have not expanded Medicaid.

In Georgia, 17% of Black adults, 29% of Hispanic adults, 13% of white adults, and 10% of Asian American adults skipped care because of cost, according to data from 2023 and 2024.

And that was before recent policy changes that have led to an increase in the number of people without health insurance, Radley said.

More than half a million Georgians have lost health insurance due to increased costs for ACA plans after a tax credit expired in December.

Rebecca Grapevine is a reporter covering public health in Atlanta for Healthbeat. Contact Rebecca at rgrapevine@healthbeat.org.

Georgia’s ACA enrollment plunges, raising concerns for rural hospitals and the whole health care market

2026-04-21T16:46:13+00:00

This story was originally published at the Georgia Recorder. Public health, explained: Sign up to receive Healthbeat’s free Atlanta newsletter here.

More than half a million Georgians have dropped health insurance coverage amid stiff premium price hikes for federally subsidized Affordable Care Act plans, according to data obtained by The Current GA and the Georgia Recorder.

The 37% enrollment drop – from 1.5 million Georgians in January 2025 to 950,000 as of April 17, 2026 — dwarfs any previous decline in the state since the launch of so-called Obamacare health insurance plans in 2014.

Rising prices for health insurance policies bought on Georgia’s health care marketplace occurred after the U.S. Congress and President Donald Trump decided against extending Covid-era “enhanced” health insurance subsidies, which sunset Dec. 31, 2025.

Preliminary data released in January about the number of Georgians enrolled in ACA plans hinted at a sizable decline of 190,000. The more complete numbers have been adjusted after those people who had been reenrolled automatically at the start of 2026 failed to make their first premium payments.

The Georgia Office of the Commissioner of Insurance and Safety Fire released the data to The Current following a public records request. It will be reported by the federal government this summer.

The steep decline sparked immediate concern from the organization that advocates for Georgia’s rural hospitals about the financial viability of these vital institutions should the data signify that Georgia’s uninsured rate has soared after years of edging down.

“I don’t know what we’re going to do, honestly” said Monty Veazey, president of the Georgia Alliance of Community Hospitals, when informed of the data by The Current. “It’s a larger number than I anticipated,” he said about the enrollment drop.

He said he was meeting with Gov. Brian Kemp next week and hoped to ask for his plans.

Drop negates recent achievements

Kemp came to office in 2019 promising to tackle Georgia’s adult uninsured rate, one of the highest in the nation. He has touted changes he oversaw to the state’s insurance market as well as the rollout of a state-based ACA marketplace called Georgia Access as solutions to this problem.

The new enrollment figures, however, raise questions about how durable those gains will be. Kemp and Insurance Commissioner John King did not comment on the enrollment figures.

Georgia’s enrollment drop dwarfs many other states’, according to partial ACA enrollment data first reported last week by the Wall Street Journal.

Fluctuations in enrollment for so-called marketplace plans are routine. But year-over-year comparisons for April also project a stark picture. In April 2025, enrollment in Georgia’s marketplace plans had already dipped to 1.3 million, according to state officials. The April 2026 data still represents a 27% drop from that level.

“It’s a really large shift in the market,” said Emma Wager, a senior policy analyst on the ACA at the health research nonprofit KFF.

There is currently no data showing whether the Georgians who dropped their marketplace insurance are now completely uninsured, or whether they took up a new kind of insurance. Some of those previously enrolled could have gotten new jobs with employer-sponsored health care, but it’s likely large numbers of them had no better options, said health policy researchers.

What Georgia can learn from states that revamped public health

In general, said Matt McGough, a policy analyst at KFF, people relying on Obamacare plans “really have nowhere else to turn.”

Wager, who emphasized that she had not seen the latest Georgia enrollment figures, said if the result in disenrollment ends up with a spike in the uninsured rates, then hospital finances across the state will be affected.

“A larger uninsured population means that hospitals have to provide more uncompensated care. And we also know that people who are uninsured are more likely to delay or forgo medical care … they may have severe needs by the time they actually see a doctor.”

Georgia has traditionally had among the three worst uninsured rates, along with Texas and Oklahoma. But lower premium prices during the pandemic helped lead to a surge of Georgia patients getting insured.

U.S. lawmakers including former Rep. Marjorie Taylor Greene said that Congress’s decision last year to allow extra subsidies to expire would put insurance out of reach for many. Extending the enhanced subsidies another 10 years would have cost $350 billion.

Democrats in Congress shut down the federal government last fall in a fight over the health insurance subsidies, but Congress did not renew the funding.

Since those extra subsidies expired, Georgians who make above a certain amount — about $64,000 for a single person — no longer get any federal assistance and must pay the full market price for health insurance. For some Georgians, the cost of premiums more than tripled.

Health providers expect hit

The loss of enrollment will send shock waves through Georgia’s health care industry. The state’s health sector was expected to lose more than $3.5 billion this year as a result of the expiring subsidies, as uninsured patients forgo care or show up in emergency rooms but can’t pay.

Georgia’s expected loss of health sector revenue from that change would be among the three largest in the nation, behind only Florida and Texas, according to the study by the Robert Wood Johnson Foundation and the left-leaning Urban Institute.

Dr. Ben Spitalnick, a Savannah pediatrician, said the premium hikes presented a budget crisis for some of his patients’ parents.

“I know patients who, this year it’s doubled for them,” Spitalnick said. “It’s insane to consider having to drop your health insurance,” he said. “If you’re, sort of solo employed or a very small business, and don’t have the comfort of either Medicaid or have a very large employer who has a large health plan, the exchange was a great option. Now it’s super expensive.”

McGough, the KFF researcher, said the ACA tends to insure people who are juggling hourly jobs or are self-employed. Self-employed often means doing gig work like driving Uber. More than a quarter of farmers and beauticians were insured through the ACA marketplace as of 2023, according to KFF.

The Affordable Care Act was passed in 2010 and the Marketplace launched in 2014. Under the ACA, the federal government mandates basic levels of care such as for prescriptions, mental health, and maternal care; and it also subsidizes premiums for certain income groups. Georgia also began its own subsidies in 2022. Starting with 2025 coverage, Georgia took over the ACA enrollment system at GeorgiaAccess.gov.

Factors influencing whether the numbers of enrollees rise or fall have included how well the system is operating, how much outreach and enrollment assistance the government enacted, and above all, how expensive coverage was. Trump in his first term pulled back on enrollment assistance, and in his second term has allowed massive pandemic-era subsidies to expire.

Georgia Recorder is part of States Newsroom, a nonprofit news network supported by grants and a coalition of donors as a 501c(3) public charity. This story was published in partnership with The Current. The Current is an independent, in-depth and investigative journalism website for Coastal Georgia.

States face another challenge with Medicaid work rules: staffing shortages

2026-04-09T14:30:30+00:00

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Katie Crouch says calling her state’s Medicaid agency to get information about her benefits can feel like a series of dead ends.

“The first time, it’ll ring interminably. Next time, it’ll go to a voice mail that just hangs up on you,” said the 48-year-old, who lives in Delaware. “Sometimes you’ll get a person who says they’re not the right one. They transfer you, and it hangs up. Sometimes, it picks up and there’s just nobody on the line.”

She spent months trying to figure out whether her Medicaid coverage had been renewed. As of late March, she hadn’t been reapproved for the year for the state-federal program, which provides health insurance for people with low incomes and disabilities.

Crouch, who suffered a debilitating brain aneurysm a decade ago, also has Medicare, which covers people who are 65 or older or have disabilities. Medicaid had been paying her monthly Medicare deductibles of $200, but she’d been on the hook for them for the past three months, straining her family’s fixed income, she said.

Crouch’s challenges with Delaware’s Medicaid call center aren’t unique. State Medicaid agencies can struggle to keep enough staff to help people sign up for benefits and field calls from enrollees with questions. A shortage of such workers can keep people from fully using their benefits, health policy researchers said.

Now, congressional Republicans’ One Big Beautiful Bill Act, which President Donald Trump signed into law last summer, will soon demand more from staff at state agencies in places where lawmakers expanded Medicaid to more low-income adults — nearly all states and the District of Columbia.

Under the law, which is expected to reduce Medicaid spending by almost $1 trillion over the next eight years, these staffers will have to not only determine whether millions of enrollees meet the program’s new work requirements but also verify more frequently that they qualify for the program — every six months instead of yearly.

KFF Health News reached out to agencies that will need to stand up the work rules, and many said they’ll need additional staff.

The mandates will put extra strain on an already-stressed workforce, potentially making it harder for enrollees like Crouch to get basic customer service. And many could lose access to benefits they’re legally entitled to, said consumer advocates and health policy researchers, some of them with direct experience working at state agencies.

States are already “struggling significantly,” said Jennifer Wagner, the director of Medicaid eligibility and enrollment at the Center on Budget and Policy Priorities and a former associate director of the Illinois Department of Human Services. “There will be significant additional challenges caused by these changes.”

Long wait times for help

Republicans argue the Medicaid changes, which will take effect Jan. 1, 2027, in most states, will encourage enrollees to find jobs. Research on other Medicaid work requirement programs has found little evidence they increase employment.

The Congressional Budget Office estimated the rules would cause more people to lose health coverage by 2034 than any other part of the GOP budget law. It said last year more than 5 million people could be affected.

Many states don’t have the staff to process Medicaid applications or renewals quickly, said consumer advocates and researchers.

The Centers for Medicare & Medicaid Services tracks whether states can handle the most common type of benefit application within a 45-day window.

In December, about 30% of all Medicaid and Children’s Health Insurance Program, or CHIP, applications in Washington, D.C., and Georgia took more than 45 days to process. More than a quarter took that long in Wyoming. In Maine, 1 in 5 applications missed that deadline.

CMS began publicly sharing state Medicaid call center data in 2023, revealing a taxed system, researchers and consumer advocates said.

In Hawaii, people waited on the phone for more than three hours in December. They waited for nearly an hour in Oklahoma, and more than an hour in Nevada.

In 2023, state Medicaid agencies began making sure enrollees who were protected from being dropped from the program during the Covid pandemic still qualified for coverage. That Medicaid unwinding process didn’t go well in many states, and more than 25 million lost their benefits.

Health policy researchers and consumer advocates say rolling out the new Medicaid rules will be a bigger challenge. The Medicaid work rules will require extensive IT system changes and training for workers verifying eligibility on a tight timeline.

“It is a much larger scale of administrative complexity,” said Sophia Tripoli, senior director of policy at Families USA, a health care consumer advocacy organization.

After months of trying to get someone on the phone, Crouch said, she finally got answers to questions about her Medicaid benefits after writing to the office of U.S. Rep. Sarah McBride, a Delware Democrat. McBride’s office contacted the state’s Medicaid agency, which eventually called with an update, Crouch said.

Crouch didn’t qualify for Medicaid after all. She said that had never come up in two years of interactions with the state.

“It makes absolutely no sense” that the state never realized she shouldn’t have been on the program, Crouch said.

Delaware’s Medicaid agency didn’t respond to requests for comment on Crouch’s situation.

States short-staffed for Medicaid

Some states told KFF Health News in late March that they’ll need more staff to roll out the work rules effectively.

Idaho said it has 40 eligibility worker vacancies. New York estimated it will need 80 new employees to handle the additional administrative work, at a cost of $6.2 million. Pennsylvania said it has nearly 400 open positions in county human services offices in the state. Indiana’s Medicaid agency has 94 open positions. Maine wants to hire 90 additional staffers, and Massachusetts wants to hire 70 more.

As of early March, Montana had filled 39 of 59 positions state officials projected it would need. The state still plans to roll out the rules early, starting July 1, despite its long struggle with system backlogs that applicants said have delayed benefits.

Missouri’s social services agency has been cutting staff and has 1,000 fewer front-line workers than it did roughly a decade ago — with more than double the number of enrollees in Medicaid and the Supplemental Nutrition Assistance Program, or SNAP, according to comments Jessica Bax, the agency director, made during a public meeting in November.

“The department thought that there would be a gain in efficiency due to eligibility system upgrades,” Bax said. “Many of those did not come to fruition.”

States could have a hard time finding people interested in taking those jobs, which require months-long training, can be emotionally challenging, and generally offer low pay, said Tricia Brooks, a researcher at the Georgetown University Center for Children and Families.

“They get yelled at a lot,” said Brooks, who formerly ran New Hampshire’s Medicaid and CHIP customer service program. “People are frustrated. They’re crying. They’re concerned. They’re losing access to health care, and so sometimes it’s not an easy job to take if it’s hard to help someone.”

States are paying government contractors millions of dollars to help them comply with the new federal law.

Maximus, a government services contractor, provides eligibility support, such as running call centers, in 17 states that expanded Medicaid and interacts with nearly 3 in 5 people enrolled in the program nationally, according to the company.

During a February earnings call, company leadership said Maximus can charge based on the number of transactions it completes for enrollees, independent of how many people are enrolled in a state’s Medicaid program.

Maximus has “no one-size-fits-all approach” to the services it offers or the way it charges for those services, spokesperson Marci Goldstein told KFF Health News.

The company, which reported bringing in $1.76 billion in 2025 from the part of its business that includes Medicaid work, expects that revenue to continue to grow, even as people fall off the Medicaid rolls, “because of the additional transactions that will need to take place,” David Mutryn, Maximus’ chief financial officer and treasurer, said during the earnings call.

Losing Medicaid health coverage isn’t just an inconvenience, since many people enrolled in the program probably don’t make enough money to pay for health care on their own and may not qualify for financial help for Affordable Care Act coverage, said Elizabeth Edwards, a senior attorney with the National Health Law Program.

People could be unable to afford medications or get essential care, which could lead to “devastating” health impacts, she said.

“The human stakes of this are people’s lives,” she said.

KFF Health News correspondents Katheryn Houghton and Samantha Liss contributed to this report, which was originally published at KFF Health News, Healthbeat’s national reporting partner.

Losing NY health coverage due to Trump cuts? Your guide to Essential Plan changes

2026-04-07T19:16:49+00:00

This story was originally published by THE CITY. Sign up to get the latest New York City news delivered to you each morning. Public health, explained: Sign up to receive Healthbeat’s free New York City newsletter here.

Nearly half a million people in New York State are poised to lose health insurance coverage as funding cuts from the Trump administration’s “One Big Beautiful Bill” begin to take effect.

On April 1, the state’s Department of Health began sending out notices to New Yorkers who receive coverage on the low-cost Essential Plan about how changes in eligibility requirements will take away their health care coverage.

The shift will affect hundreds of thousands of working, low-income New Yorkers who don’t qualify for Medicaid. Are you among them?

Here’s what we know about how the funding cuts will affect coverage, what people can do to stay insured, how to access care without insurance and the battle playing out in Albany to cover the costs.

Why is this happening and who is affected?

President Donald Trump signed a massive tax and spending bill in July 2025, including cuts to federal funding for New York’s Essential Plan. About 450,000 people will no longer be eligible for the program beginning July 1, even after New York state got approval from the federal government to keep about 1.3 million people enrolled.

The cuts primarily affect people with incomes from 200% to 250% of the federal poverty line, which this year equals yearly earnings of about $32,000 and $40,000 for an individual, or $54,000 to $68,000 for a family of three, according to Elisabeth Benjamin, vice president of health initiatives for the Community Service Society.

Q&A: How federal funding cuts will cost 500,000 New Yorkers their health insurance

“These are not wealthy people,” Benjamin said. “It will be much more expensive. They’re going to lose their free, no-deductible coverage, and instead have to pay hundreds of dollars [per month], potentially, for a product with a deductible.”

With the state budget not yet finalized, advocates and officials are pushing Gov. Kathy Hochul to find the money to prevent so many people from losing health coverage.

The cuts will also impact legal immigrants in New York on the Essential Plan by eliminating their premium tax credit eligibility entirely, Michael Kinnucan, health policy director at the Fiscal Policy Institute, said in an interview with Healthbeat.

What should I do if I’m losing health care?

If you are set to lose health care through the Essential Plan on July 1, use the next three months to seek care, Rebecca Wallach, director of New York Legal Assistance Group’s legal resources program, told THE CITY.

“Make an appointment to see a primary care doctor, get prescriptions in order, get whatever you need,” she said.

Pay attention to notices from the New York State of Health Marketplace, whether online or by mail, informing people of when they will lose health care and how they can purchase a new plan on the private market.

On May 16, you can begin shopping for Qualified Health Plans on the Marketplace, which can connect you with health care navigators trained to assist in the enrollment process. You have until Aug. 30 to pick a new insurance plan, said Danielle Holahan, executive director of the New York State of Health. Remember, however, that you will lose insurance coverage on July 1 no matter what, so if you’re still choosing a plan after July 1 and before Aug. 30, you’ll be uninsured during that time.

Call the Marketplace’s Customer Service Center at (855) 355-5777 with any questions. It is open weekdays 8 a.m. to 8 p.m., and Saturdays 9 a.m. to 1 p.m. For help in languages other than English and Spanish, call and request an interpreter.

People walk in and out of Woodhull Hospital in Brooklyn in January.

“We will do what we can to smooth this transition,” said Holahan. “We will work with them to let them know what timeline this is all happening on, when they can come in and pick a plan that would take effect on July 1.”

The experts THE CITY spoke to all said it is critical to meet with health care navigators — trained individuals whose job it is to help people through the byzantine process of getting insured. Mid-May and June are the time to start reaching out, according to Wallach.

This is especially important if your life or home circumstances have changed since the last time you signed up for insurance, like if you are pregnant, have welcomed a new baby into your household, or your income has gone down. These navigators will assist you according to your individual needs.

“It’s really important to have to redo your financial eligibility,” Benjamin said. “If your income this year isn’t as high as last year, you might still be able to get the free coverage.”

The Community Service Society partners with New York state to connect people with trained navigators. It has 17 community-based organizations that will assist you for free as part of its Navigator Network, which can be found here.

Rehan Mehmood is the director for health services and a health care navigator at the South Asian Council for Social Services, one of the organizations in the Navigator Network with an office in Flushing, Queens. He said appointments are not necessary — just walk in, and they will help you.

“Our people will make sure you have access to health care,” Mehmood said. “We speak over 20 different languages. We can assist individuals going through plans, seeing what services are covered and helping them get the care they need.”

Holahan recommends that people not put off choosing a new plan.

“They can always make a change later, but I would encourage people to take action so there’s no gap in coverage,” she said.

If you speak to a navigator and are not eligible for insurance through the New York State of Health, the state’s health marketplace, but have a medical condition that affects your daily activities, Wallach advises reaching out to the Facilitated Enrollment for the Aged, Blind and Disabled — an application assistance program for public health insurance.

Those who could consider FE-ABD include New Yorkers with active cancer treatment, who receive dialysis or have multiple sclerosis, Wallach said.

“For an individual who is not able to get insurance through those systems in New York State of Health, FE-ABD can evaluate and screen a person for the possibility of Medicaid,” she said.

The Community Service Society’s network list of community-based organizations in the FE-ABD Program can be found here. The Department of Health also has a list of facilitated enrollers for FE-ABD, which can be found here.

What if I become uninsured, or cannot afford the insurance I am eligible for?

If you have exhausted your options to access an insurance plan you can afford, the city has a safety net program administered through NYC Health + Hospitals for getting the care you need: NYC Care.

“It is one of the major avenues where we can make sure clients are connected to comprehensive health care,” Mehmood said.

Anyone within the five boroughs who is uninsured or cannot afford the insurance for which they are eligible can access NYC Care.

NYC health department submits budget plan while bracing for potential federal funding cuts

NYC Health + Hospitals administers the program and provides free or low-cost services at the facilities listed here. The enrollment process is outlined here, or you can call (646) 692-2273 for information on how to become a NYC Care member.

These services are available regardless of immigration status, and health care professionals will not record your immigration status, according to the NYC Health + Hospitals website.

There are also free health clinics funded through grants from the U.S. Department of Health and Human Services, where people can seek ongoing care. Enter your location here to find one.

And if you have a medical emergency, do not put off care. “Go to the emergency room,” Wallach said. “That is still true.”

What about accessing the medicine I need while uninsured, or struggling to afford medication?

You can access medication as a NYC Care member, but Wallach said there are other ways to afford many of the medications you need on an ongoing basis.

Seek prescription drug discount programs, like GoodRx that compare prescription drug prices and tell you what pharmacies take specific insurance. NPR also has a good guide on how to get the best price for your prescription when navigating drug discount options.

Can the state make up the Essential Plan funding that the federal government cut?

Gov. Kathy Hochul maintains that the state cannot take on the costs of the cuts to provide coverage for people who will lose their health insurance.

“From the beginning, I sounded the alarm about the devastating impact H.R. 1 would have on our hospitals and health care system, and made clear that no state can fully backfill cuts this severe,” she said in an April 1 statement.

But Benjamin from the Community Service Society said with the state budget yet to be finalized this spring, “it’s not over yet.”

“It can be done for just under a billion dollars. The money’s there,” she said; the entire state budget is about $260 billion. “Get ahold of your state elected officials and the governor to say we don’t have to lose our coverage.”

State Sen. Gustavo Rivera and Assemblymember Amy Paulin introduced legislation last week that would protect half a million people from losing coverage through state funding. The bill has 10 co-sponsors in the Senate.

“We can absolutely cover folks,” Rivera told THE CITY. “You would have 450,000 New Yorkers who without any action would lose their coverage come July.”

“That’s going to happen regardless,” he said. “Since it’s happening during this budget year that we’re negotiating right now, we have to do something.”

Holahan from the Department of Health echoed the governor’s sentiment. “The governor has been pretty clear, states cannot backfill cuts of this magnitude,” she said. “It’s not something that we wanted to do, but the federal government had different ideas.”

Wallach noted that “We do not know where the budget is going to fall, so the advice could change.”

But Mehmood said that currently, Essential Plan enrollees who make up to 250% of the federal poverty line will lose coverage.

“Legislators are still pushing,” he said. “But as of now, what we know is that July 1 is the last day.”

Q&A: How federal funding cuts will cost 500,000 New Yorkers their health insurance

2026-03-27T10:00:00+00:00

Public health, explained: Sign up to receive Healthbeat’s free New York City newsletter here.

The massive federal budget cuts imposed by the Trump administration’s One Big Beautiful Bill Act are beginning to play out. In New York, almost a half-million people are expected to lose their health insurance coverage through the state’s Essential Plan on July 1.

The U.S. Centers for Medicare and Medicaid Services granted the state’s request to revert to an earlier plan in a move that will maintain coverage for 1.3 million low-income New Yorkers. But almost 500,000 will be left without, because they will no longer meet the Essential Plan’s income limit - which is being reverted to $31,920 a year for an individual and $66,000 for a family of four.

The state’s health department has said it will send notices to those affected on Wednesday, laying out their options and next steps.

Michael Kinnucan is the health policy director at the Fiscal Policy Institute, an independent nonpartisan think tank that aims to promote sound and equitable fiscal policy to strengthen New York’s economy.

Kinnucan met with Healthbeat to discuss the Essential Plan — how it works, how it’s been successful, how the cuts will likely play out, and what that means for the broader health care system.

Many of those who lose coverage can turn to the individual market, but the premiums will be much higher and many people won’t be able to afford it. And increasing the number of uninsured people affects the whole community, he said.

“We all go to the same hospitals and doctors, and if half a million people suddenly lose coverage and aren’t able to go to the hospital or the doctor, that feeds through into hospital closures, into long wait lines at the emergency room,” Kinnucan said.

This interview has been edited for clarity and length.

Can you begin by telling us how the Essential Plan works?

The Essential Plan is a unique feature of the health care landscape in New York. It’s something we do differently from almost every other state in the country. In New York, the Essential Plan covers people who earn less than 250% of the federal poverty line, and who are not eligible for Medicaid, either because they earn too much or because they have a legal citizenship status that prevents them from getting Medicaid.

It’s a big program. It covers 1.7 million New Yorkers, and it provides high-quality, very cheap, or mostly free, health insurance to a low-income population — people making up to $40,000 a year for an individual. It’s federally funded, but it’s state-administered. If you go to the New York state health exchange website to sign up for insurance, and it turns out that you’re in an income category and other aspects of your life make you qualified for the Essential Plan, you get this very low-deductible, low-pay, high-quality insurance.

In other states, the equivalent population would buy health insurance on the individual marketplace, and they would get federal premium tax credits to subsidize them. But in New York, the state takes the federal funding and runs the central plan.

The Essential Plan enrollment has grown since it was launched in 2015, right?

[Enrollment has grown from 380,000 in 2016 to 1.7 million in 2025, according to the Community Service Society, a New York-based nonprofit that studies affordable housing and health access. Its popularity stems from lack of monthly premiums and deductibles, comprehensive health benefits, and limited cost sharing.]

That’s right. It’s been a real policy success story. Because it’s low cost, many people enroll in it, and in particular, many healthy people enroll in it, which keeps costs really low. And the result of that is actually the federal funding we currently get to run it has historically been more than enough to support the whole program because costs are very low, lower than they were initially expected.

It’s grown a lot. In 2024, the state was like, boy, this is working so well that they actually did a significant expansion of eligibility for the Essential Plan. Before 2024, you had to earn less than 200% of the federal poverty line to qualify. After 2024, it went up to 250% of the federal poverty line.

But because it’s low cost, because it’s a very efficient program, and a lot of healthy people enroll and keep costs down for everyone, it hasn’t cost the state any money to run the program. It’s been more than fully covered by those federal subsidies that in other states, they would help people buy insurance on the individual market. In New York, we use them to buy people Essential Plan coverage instead.

More recently, H.R. 1, the One Big Beautiful Bill Act, imposed cuts that will affect the Essential Plan. What do those cuts mean for Essential Plan enrollees?

The cuts applied specifically to legal immigrants. Undocumented immigrants are almost entirely not eligible for federal health care subsidies of any kind, be it Medicaid, the Essential Plan, or premium tax credits, but H.R. 1 cut a whole bunch of legal immigrants off from federal health care benefits.

What it did, specifically with those populations, is it made them ineligible for premium tax credits all across the country. If you’re, let’s say, a green card holder, and you drive a cab, you need to buy insurance on the individual market, you’re no longer eligible for premium tax credit, so that plan is going to cost you $10,000 to $12,000 a year.

In New York, because we operate differently with the Essential Plan, the equivalent cut was they cut off federal funding to support legal immigrants who are enrolled in the Essential Plan. That’s a minority, but a very large part of the central plan enrollment.

Roughly speaking, of the 1.7 million people on the Essential Plan, about a million are U.S. citizens, and about 700,000 are lawfully present immigrants. All the funding for them got cut by H.R. 1. What that meant was that group didn’t get kicked off the Essential Plan — they’re still on the Essential Plan. What it meant was that the Essential Plan as a whole is really underfunded. It lost almost half of its federal funding, and that’s forcing the state to make tough decisions.

What do these decisions mean for EP enrollees?

The funding cut from H.R. 1 has been so severe and threatening to the Essential Plan that many of us thought that it might need to be shut down entirely, which would have been a real catastrophe. It would have meant 1.7 million people losing health insurance. The state of New York came up with an alternative to shutting it down, which is to to shrink eligibility — to undo that expansion that happened in 2024 and reduce eligibility back to 200% of the federal poverty line.

It will be a smaller plan that will be cheaper to support. The state can continue to run the plan for everyone else below 200% of the poverty line indefinitely. Their coverage will be protected under this plan, but the people who are between 200% and 250% of the poverty line will be kicked off the Essential Plan. These are quite low-income people. They’re earning between $35,000 and $40,000 a year for a single individual. That eligibility group is about 470,000 people.

Those are the people who are going to lose coverage under the state’s new plan for the Essential Plan. They’re going to lose coverage really quickly, starting this July. It’s very concerning.

What happens next for enrollees?

Most but not all of this population are U.S. citizens. Most of them will be eligible to go in the individual market and purchase health insurance. They’ll be able to get premium tax credits to support that. But the truth is there will be a big struggle to afford health insurance.

Again, these folks are making $35,000 to $40,000 a year. Even with the individual market, even with premium tax credits, they’ll be paying $250 a month out of pocket. They’ll face really high co-pays. The truth is that it’s likely that many, many, many people in this population — probably more than half — are not going to be able to afford that coverage, and they’ll become uninsured.

There’s a separate, smaller group within this population who are lawfully present immigrants, and H.R. 1 actually made them disqualified for premium tax credits. That group, which is maybe 50,000 to 100,000 people — no one exactly is sure — will have no source of alternative coverage. In theory, they could still buy health insurance on the individual market, but they’d be paying over $1,000 a month. Given their incomes, there’s no way they’d be able to afford it.

To summarize, the majority of this population who are U.S. citizens, they may be able to get health insurance in the individual market, but it’ll be a very tight squeeze, and many of them will likely not be able to afford it and become uninsured. And there’s a smaller group of immigrants in this population who will have no source of alternative coverage and will almost certainly become uninsured.

What can the state do to help?

The good news is that the Essential Plan is incredibly cheap and efficient to offer as health insurance, and that’s because it’s low cost. It has a relatively healthy, low-cost enrollment population. The state does a great job of regulating the rates that Essential Plan pays providers. That makes it much cheaper to offer than commercial insurance.

The state was preparing and reserving money for the eventuality where the Essential Plan had to be eliminated, and that would have increased the state’s costs to cover different populations. Now that we know the Essential Plan will be around and it will cover most of its current population, we actually have $2.5 billion allocated in the state budget, which would be more than enough to cover the population at risk of losing coverage now and then.

The state said in a press release this week that it cannot make up for these cuts, but is working with insurers to ensure that anyone moving from the Essential Plan to a Qualified Health Plan mid year will see their deductible cut in half.

I don’t know how to say this politely: It’s not true that the state can’t make up for the cuts. The state has a $260 billion a year budget. It could fully replace this coverage for this group of half a million New Yorkers for far less than 1% of that budget. It is well within the state’s fiscal capacity to protect New Yorkers’ coverage.

As the state legislators negotiate in the budget, it’s their responsibility to make sure that does happen. Cutting people’s deductible in half is good, as far as it goes. It’s better than nothing, I suppose, but it is not remotely a replacement for Essential Plan coverage, which was free, as opposed to $250 a month, and which had very, very low deductibles, as opposed to the 2020 $500 deductibles that are common in exchange plans.

Is there anything you’d like to add?

The Essential Plan cliff happening in July, where half a million people are threatened with loss of insurance, is going to affect those people quite a bit. It’s also going to affect their entire communities and the health care providers in their neighborhoods.

We all depend on the same health care system. We all go to the same hospitals and doctors, and if half a million people suddenly lose coverage and aren’t able to go to the hospital or the doctor, that feeds through into hospital closures, into long wait lines at the emergency room, etc., etc. It’s really a shared interest for all of us to make sure that everyone is covered.

Trenton Daniel is a reporter covering public health in New York for Healthbeat. Contact Trenton at tdaniel@healthbeat.org or on the messaging app Signal at trentondaniel.88.